<?php
//$title is the page title
$title = "csweb Registration";
require('includes/header.php');

?>

<script type="text/javascript" src="validate.js"></script>



</head>
<body>

    <div id="doc3" class="yui-t7">
        <div id="hd"><h1>csweb Registration</h1>
        </div>
        <div id="bd">
            <div class="yui-g">
                <div class="registrationdiv" align="center">
                    <h3>Please enter your information</h3>
                    <form method="post" action="validate.php">
                        <div class="inputrow">
                            <label for="Email">Email:</label>
                            <input id="Email" size="20" maxlength="32" type="text" name="Email" /><span id="status" class="regerror"></span>
                        </div>
                        <div class="inputrow">
                            <label for="Password">Password:</label>
                            <input id="Password" maxlength="32" size="20"  type="password" name="Password" /><span id="pstatus" class="regerror"></span>
                        </div>
                        <div class="inputrow">
                            <label for="confirm">Confirm Password:</label>
                            <input size="20" maxlength="32" id="confirm" type="password" name="Confirm_Password" /><span id="cstatus" class="regerror"></span>
                        </div>
                        <div class="inputrow">
                            <label for="First">First Name:</label>
                            <input size="20" id="First" maxlength="32" type="text" name="First" /><span id="fstatus"></span>
                        </div>
                        <div class="inputrow">
                            <label for="Last">Last Name:</label>
                            <input size="20" maxlength="32" id="Last" type="text" name="Last" /><span id="lstatus"></span>
                        </div>
                        <div class="inputrow">
                            <label for="Zip">Phone:</label>
                            <input size="3" maxlength="3" id="Zip" type="text" name="Zip" />-
                            <input size="3" maxlength="3" type="text" id="Firstp" name="Firstp" />-
                            <input size="4" maxlength="4" type="text" id="Lastp" name="Lastp" /><span id="phstatus"></span>
                        </div>
                        <div class="inputrow">
                            <label for="office">Office:</label>
                            <input size="10" maxlength="8" id="office" type="text" name="Office" /><span id="ostatus"></span>
                        </div>

                        <div class="registrationbuttons">
                            <input type="reset" id="reset" value="reset"  />
                            <input type="submit" id="submit" value="submit" name="submit" />
                        </div>

                    </form>

                </div>
            </div>

        </div>
        <div id="ft"><p>csweb Site Copyright &copy; 2009</p></div>
    </div>

</body>
</html>